Gut Health
I have a chronic fatigue patient who took a lactulose breath test. Results came back with zeros across the board, so I suspect hydrogen sulfide production. My question is, in a case like this, how long do you treat for during a therapeutic trial? Also you say retesting isn’t useful in these cases, but wouldn’t you expect eradication of hydrogen sulfide producing bacteria to result in a normal single peak as the lactulose enters the colon. Finally, would you usually add liver support with these cases, as you suggest normal detox may be impaired?
Chris Kresser: I think we addressed some of this in my earlier response [to question #8], but for a therapeutic...
In Week 10, we got a handout of the pediatric botanical protocol for SIBO. Is this the same protocol we should use to treat parasites in pediatric patients? I’m having a hard time locating the CSA tincture. Where do you source that from?
Chris Kresser: Yeah, it can still be effective for parasites. It depends on the age, and it depends on what...
Questions about low sIgA with normal blood levels: Some of this info has been peppered throughout the course, but I was wondering if you could provide an overview. Can you comment on the pathophysiology? Is the sIgA being used up fighting an infection? Does the inflammation in the gut prevent the IgA in the blood from being distributed to the lumen? Do you target sIgA specifically, or should it be assumed to increase on its own with proper treatment of underlying conditions? Is sIgA low more often with certain infections, i.e., SIBO versus yeast overgrowth?
Chris Kresser: Unfortunately we don’t know that much about sIgA, and what I have come to after pretty extensive research...
If a patient has a flatline result on a SIBO breath test and you treat as positive for hydrogen sulfide bacteria, is there a way to retest to make sure treatment is successful? Even though the breath test is not measuring for hydrogen sulfide, could you expect that a repeated breath test would show a normal result or at least a
Chris Kresser: This is the problem with the hydrogen sulfide hypothesis and diagnosis: There isn’t really a surefire way to...
I wondered if we could have your expertise on the lowdown of burping. I know it’s usually associated with low stomach acid fermentation, but I have also recently heard about it being potentially high stomach acid too. Does it always come from the stomach or could it be originating in the small intestine? What do you suggest for people who that is a predominant issue?
Kelsey Marksteiner: Okay. So yes, burping can definitely be related to low stomach acid and I would recommend thinking about...
I would like to ask your opinion with a 70-year-old client that I’ve had for the last year, who has had gut issues since he was in his 20s. The fear he has about having symptoms is really preventing him from including foods in his diet. Also every time we include a new fruit or vegetable, low FODMAP, he has bloating and gas, and once in a while he has really bad diarrhea. I feel that he has been used to limiting his food intake to control his symptoms, but he’s not solving the problem. What would you try in a situation like that?
Laura Schoenfeld: This, to me, sounds more like a psychosomatic effect of the food as opposed to the food actually...
I’m working with a patient who has had her colon removed due to polyps. She now has polyps in her small intestine, which have been partially addressed surgically, and her doctor wants to do preventative chemo to prevent what they removed from coming back. I have a few questions. Is there any way not to have SIBO? Where else would the bacteria go? (2) What would you be doing for her in terms of diet? (3) What do you think of the idea of taking transient probiotics for life while also following a low-FODMAP diet? I’m hoping the probiotics would do their job as they pass through her system, but would not take up residence.
Kelsey Marksteiner: What a unique situation here. Let me think about this for a minute. She only has her small...
If a patient has never had digestive or other obvious symptoms from gut problems, how can we determine whether or not they can eventually add back in any foods we might have removed? In other words, if we can’t track effects of foods based on symptoms alone, how will we know if we can then add foods back in at some point?
Kelsey Marksteiner: I totally understand what you’re saying when you say if patients don’t have digestive symptoms from eating certain...
During the discussion of the DUTCH hormone test, you mentioned that gut issues can contribute to low free cortisol levels. Can you go over that connection again?
Chris Kresser: Some of this might be personal, so I’m not going to read it, but the gist of the...
I’d like your opinion on this test. Doctor’s Data positive for H. pylori. Beneficial flora: 2+ Bacteroides fragilis, 1+ Bifido, 3+ E. coli, 1+ Lacto, no growth Enterococcus, 3+ Clostridium. Commensal: 4+ alpha-hemolytic, 2+ beta-strep group B.. No yeast. Everything else in range except occult blood that’s positive. Patient treated SIBO last year and retested last April and came back negative. Treated H. pylori two years ago. Breath test was positive and treated following doctor’s recommendation. Symptoms are bloating with gas. Following guidance with diet. Patient regained 16 pounds of weight,” so I guess they were underweight, “but still needs to gain a few more pounds to be back to normal weight. Vertigo and dizziness, headaches, brain fog, and more. Paleo for two years, but was on a long-time very-low-carb diet, trying to manage symptoms, but it made her worse and had a huge overall improvement in health since working.
Chris Kresser: I think the H. pylori is the big question mark here because there was a history of that...
